Michigan Entity Annual Report Waiver Form

In the case of a business entity missing submitted a required annual report and want to avoid paying penalty in the State of Michigan, the Michigan Entity Annual Report Waiver Form has to be completed and submitted.

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BCS/CD-313 Re	v 04/2011 	
LARA is an equal opportunity employer/program.  	
Auxiliary aids, services and other reas onable accommodations are available upon re quest to individuals with disabilities. 	
MICHIGAN DEPA	RTMENT OF LICENSING AND REGULATORY AFFAIRS 	
BUREAU OF COMMERCIAL SERVI CES, CORPORATION DIVISION 
P. O. Box 30054, Lansing, Michigan 48909 
 	
Waiver Statement 	
 
I hereby request a waiver of any late fees assess ed for the late filing of the annual report year(s) 
___________________________ for ID# _________ 
entity name __________________________________________________ 
pursuant to Section 921 of Act 284 of 1972, as amended.  For the reasons checked below, the 
annual report was not timely filed. 
 	
  The annual report was timely filed but with some other agency, either of this State\
,  another state, or with the Federal government. 
 
  The annual report was timely mailed along with the appropriate fee but was lost in the  mail. 
 
  The accountant, bookkeeper, or other person formally delegated the responsibility for  the filing of the annual report was unable to do so in a timely fashion as a result of 
circumstances clearly beyond that person’s control. 
 
The matters set forth above are true, and I am currently an officer of the corporation authorized 
to execute documents such as this waiver statement on behalf of the corporation. 
 
I understand that any waiver of penalties does not constitute a waiver of the $25.00 filing fee or 
the obligation to file the annual report.  I also understand that failure to file an annual report will 
ultimately result in the automatic dissolution of a Michigan corporation or revocation of a foreign 
corporation’s certificate of authority.  Corporations dissolved or revoked are not eligible for a 
waiver. 
 
_____________________________________ __________________________________\
____ 
 	
(Print Name)	 	(Print Title) 	
 
_____________________________________ __________________________________\
____ 
   (Authorized Signature)      (Date)   
 
 	
BUSINESS CORPORATION ACT (EXCERPT) 
Act 284 of 1972  
450.1932 False or fraudulent report, certificate, or statement; fals ification or alteration of books, records, or accounts; penalties. 
 
Sec. 932. 
 
A person who knowingly makes or files or a person who knowingly  assists in the making or filing of a false or fraudulent report, 
certificate, or other statement required by this act to be fil ed by a domestic or foreign corporation with a public officer of  this state, or 
a person knowing the same to be false or fraudulent, who procures , counsels, or advises the making or filing of a report, certificate, 
or statement, is guilty of a misdemeanor and is subject  to a fine of not to exceed $1,000.00 for each offense. 
 
An officer or agent of a corporation who knowingly falsifies or  wrongfully alters the books, records, or accounts of a corporat ion is 
guilty of a misdemeanor and is subject to a fine of  not to exceed $1,000.00 for each such offense. 
 
History:  1972, Act 284, Eff. Jan 1,  1973 ;--Am. 1989, Act 121, Eff. Oct1, 1989